No Significant Radiological Signs of Adult Spinal Deformity Progression after a Mean of 11 Years of Follow-Up Following Harrington Rod Instrumentation Removal and Watchful Waiting.

The study aimed to assess long-term radiological outcomes in patients from our institution who were primarily treated for adolescent idiopathic scoliosis with surgical correction using Harrington rod (HR) instrumentation, and afterward with watchful waiting of residual spinal deformity after HR removal, whereby no patient consented to spinal deformity correction. A single-institution case series of 12 patients was retrospectively evaluated. Preoperative and most recent post-instrumentation removal radiographic measurements were compared, along with baseline characteristics. The average age of patients (all females) at the time of HR instrumentation removal was 38 ± 10 years (median 40, range 19-54). The mean follow-up from the HR instrumentation implantation to the HR instrumentation removal was 21 ± 10 years (median 25, range 2-37), with a further mean of 11 ± 10 years (median 7, range 2-36) of follow-up following HR instrumentation removal and watchful waiting. No significant change in radiological parameters was observed: LL (p = 0.504), TK (p = 0.164), PT (p = 0.165), SS (p = 0.129), PI (p = 0.174), PI-LL (p = 0.291), SVA (p = 0.233), C7-CSVL (p = 0.387), SSA (p = 0.894), TPA (p = 0.121), and coronal Cobb angle (proximal (p = 0.538), main thoracic (p = 0.136), and lumbar (p = 0.413)). No significant change in coronal or sagittal parameters was observed in this single-institution long-term radiological outcome study of adults following HR instrumentation removal and watchful waiting of residual spinal deformity.

Ossification of ligamentum flavum related to progressive thoracic myelopathy and acute paraplegia in a Central-European male with a thoracic kyphoscoliosis.

The ossification of the ligamentum flavum (OLF) presents a significant risk factor in the development of spinal cord compression in the (lower) thoracic spine, particularly in eastern Asian elderly males. The definite causes for OLF have not yet been fully uncovered, whereby age, genetics, metabolic disorders and mechanical stress are deemed among the most plausible pathophysiological factors in OLF. Spinal deformities (mostly kyphotic) are associated with an excess in tensile forces, which may lead to hypertrophy and OLF. This unique case of OLF-related acute paraplegia and progressive thoracic myelopathy in a Central-European male patient may indicate the role of a (kyphoscoliotic) spinal deformity in the initiation and progression of the OLF-related (thoracic) myelopathy. Promptly initiated surgical decompression and (partial) deformity correction may, along with proper subsequent intradisciplinary rehabilitation process, greatly improve the clinical outcome post-treatment, especially in terms of quality of life and residual pain.

Case Report: Campylobacter fetus caused pyogenic spondylodiscitis with a presentation of cauda equina syndrome after instrumented lumbar fusion surgery.

Spondylodiscitis with/without neurologic impairment is a serious infection, predominantly occurring in high-risk patients. Campylobacter fetus caused spondylodiscitis is very rare. Evidence-based therapeutic concepts for lumbar spondylodiscitis are lacking. A 64-year-old high-risk woman underwent decompression with instrumented lumbar fusion. Six months after index surgery, she developed pyelonephritis, which deteriorated to sepsis and presentation of cauda equina syndrome. She underwent urgent revision with decompression, debridement, and instrumentation removal, and received long-term antibiotics. Culture grew Campylobacter fetus, previously not reported as a cause of spondylodiscitis after elective instrumented lumbar fusion. Emergent debridement and removal of instrumentation, with 2 months of targeted intravenous antibiotics followed by 6 weeks of oral antibiotics led to complete spondylodiscitis resolution. Prompt diagnostics and targeted antibiotic treatment are paramount when dealing with spinal infections, particularly in patients with rare causative pathogens like Campylobacter fetus. Concomitant neurological complications may require emergent surgical management in the case of cauda equina syndrome.

The Surgical Treatment of Osteoarthritis.

Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

Outcome after Two Sequential Revision Hip Arthroplasties for CoC Bearing Fracture with 10 Years Follow-up: A Case Report.

INTRODUCTION: Revisions due to the fracture of ceramic-on-ceramic (CoC) bearing are rare, however when they occur, they represent a major challenge to an orthopedic surgeon for ensuring safe and long-term survival of the replaced bearing. CASE REPORT: We present a case of fractured ceramic liner of total hip prosthesis that underwent revision to a metal-on-polyethylene (MoP) bearing couple, with consequent huge periprosthetic metallosis. Shortly after, the second revision operation followed using the third bearing couple of ceramic-on-polyethylene (CoP). At 10 years follow-up after the operation due to ceramic fracture, the patient is now pain free with full range of motion of the revised hip. CONCLUSION: Establishment of diagnostic routes and recommended protocols for CoC bearing fracture would allow easier recognition of potential fracture and diminish its consequences for the patients.

Cross-cultural adaptation and validation of the Slovenian version of the Core outcome measures index for low back pain.

BACKGROUND: To conduct a cross-cultural adaptation and validation of the Core Outcome Measures Index (COMI) in the Slovenian language, for use in patients with low back pain. METHODS: The English version of COMI was translated into Slovene following established guidelines. Three hundred fifty-three patients with chronic low back pain were recruited from the Orthopedic clinic department of a tertiary care teaching institution. Data quality, construct validity, responsiveness, and test-retest reliability of the COMI were assessed. RESULTS: The questionnaire was generally well accepted with no missing values. The majority of items exhibited only mild ceiling effects (below 20.0%) and somewhat more prominent floor effects, which were similar to previous studies (4.5-78.8%). Correlations with Oswestry Disability Index (ODI) were high (ρ = 0.76 between overall COMI and ODI scores), suggesting that the Slovene version of COMI had high construct validity. Additionally, the Slovene version of COMI successfully captured surgical patients' improvement in their low back problem after surgery (overall COMI score change: Z = - 9.34, p < .001, r = - 0.53) and showed acceptable test-retest reliability (ICC = 0.86). CONCLUSIONS: The Slovene version of COMI showed good psychometric properties, comparable to those of previously tested language versions. It represents a valuable instrument for the use in future domestic and multicenter clinical studies.

Comparative Analysis of Combined (First Anterior, Then Posterior) Versus Only Posterior Approach for Treating Severe Scoliosis: A Mean Follow Up of 8.5 Years.

STUDY DESIGN: A retrospective, one center, institutional review board approved study. OBJECTIVE: Two methods of operative treatments were compared in order to evaluate whether a two-stage approach is justified for correction of bigger idiopathic scoliosis curves. Two stage surgery, combined anterior approach in first operation and posterior instrumentation and correction in the second operation. One stage surgery included only posterior instrumentation and correction. SUMMARY OF BACKGROUND DATA: Studies comparing two-stage approach and only posterior approach are rather scarce, with shorter follow up and lack of clinical data. METHODS: Three hundred forty eight patients with idiopathic scoliosis were operated using Cotrel-Dubousset (CD) hybrid instrumentation with pedicle screw and hooks. Only patients with curvatures more than or equal to 61° were analyzed and divided in two groups: two stage surgery (N = 30) and one stage surgery (N = 46). The radiographic parameters as well as duration of operation, hospitalization time, and number of segments included in fusion and clinical outcome were analyzed. RESULTS: No statistically significant difference was observed in correction between two-stage group (average correction 69%) and only posterior approach group (average correction 66%). However, there were statistically significant differences regarding hospitalization time, duration of the surgery, and the number of instrumented segments. CONCLUSION: Two-stage surgery has only a limited advantage in terms of postoperative correction angle compared with the posterior approach. Posterior instrumentation and correction is satisfactory, especially taking into account that the patient is subjected to only one surgery. LEVEL OF EVIDENCE: 3.

Metal-on-metal vs. metal-on-polyethylene total hip arthroplasty tribological evaluation of retrieved components and periprosthetic tissue.

BACKGROUND AND PURPOSE: Metal-on-metal (MoM) bearings were introduced as an alternative to conventional metal-on-polyethylene (MoP) bearings to reduce the wear and to increase the survival of hip prostheses. The goal of the present study was to compare tribological properties and to evaluate periprosthetic tissue reaction in two identical groups of prostheses differing only in the type of bearings. PATIENTS AND METHODS: At revision operations 26 MoM and 12 MoP bearing components and perisprosthetic tissue samples were collected. Prosthetic components were used to assess wear damage, linear and volumetric wear and roughness. Periprosthetic tissue samples were used for histological as well as immunohistochemical analysis and isolation and characterization of wear particles. RESULTS: The mean linear wear rate in the MoM group was 2.34 (SD 1.93)µm/year, significantly lower than the value in the MoP group, 11.52 (SD 7.82)µm/year. Significantly lower was also the volumetric wear, 0.19 (SD 0.32)mm(3)/year for MoM compared to 0.98 (SD 0.78)mm(3)/year for MoP. In both groups the main wear mode was abrasive wear. Histological results for MoM group indicate more lymphocyte dominated periprosthetic tissue reaction compared to MoP group. The mean size of polyethylene particles in the MoP group was 0.21 (SD 0.44)µm. In the MoM nanosized CoCrMo particles were identified. The characterization of metal particles was complex and required special attention in terms of instrumentation (field emission scanning electron microscopy in back-scattered mode); otherwise it was difficult to distinguish metal particles from other particles in the tissue. CONCLUSIONS: Despite a significantly lower wear and, consequently, smaller load of periprosthetic tissue with wear particles in the MoM group, the tissue reaction was similar, if not more intense than in the MoP group.

A comparative study of four bearing couples of the same acetabular and femoral component: a mean follow-up of 11.5 years.

We present a retrospective evaluation of 1369 hip arthroplasties performed using the Bicon-Plus cups and SL-Plus stems, differing only in the bearing combination. Four bearing combination groups were used: metal-on-polyethylene (MoP) group with 587 hips, ceramic-on-polyethylene (CoP) group with 161 hips, metal-on-metal (MoM) group with 322 hips and ceramic-on-ceramic (CoC) group with 299 hips. The mean follow-up was 11.5 years (4.1 to 15.0). Radiological evaluation was performed on implants failed due to aseptic loosening. The survival for prosthesis with revision for any reason at ten years was 96.1% (95% confidence interval (CI) 94.3 to 97.9) for MoP, 98.1% (CI 95.9 to 100) for CoP, 90.2% (CI 86.8 to 93.6) for MoM, and 95.6% (CI 93.0 to 98.2) for CoC. Survival for aseptic loosening was also determined.